Case presentation
Our patient is a 67-year-old man with a history of hypertension who presented to our clinic with a history of fever and cutaneous eruptions.
He had received the first dose of Sinopharm COVID-19 vaccine (BBIBP-CorV) with a dose of 0.5 mL given intramuscularly six days before the development of his lesions. His manifestations started with fever and erythema patches on his back followed by bullous lesions on the lower extremities. He was seen in another health care center and was given acetaminophen, cetirizine, and vitamines and did not notice any improvement. Seven days after vaccination, lesions developed on his body, and the genital mucosa was involved.
He had no history of taking any new medication in the past one month before the development of the skin lesions and he had a history of COVID-19 infection 3 months ago.
On physical examination, all mucosal surfaces were involved. Bilateral conjunctivitis with purulent and oral and genital ulceration and hemorrhagic crusting over his lips.
He had numerous purpuric and dusky patches involving the back, chest, abdomen, both extremities, and face, with flaccid bullae and areas of epidermal detachment. He had positive Nikolsky’s sign. His body surface area (BSA) involvement is estimated to be more than 30%. Laboratory findings showed elevated D-dimer [2626], erythrocyte sedimentation rate (ESR)[64 mm/h], C-reactive protein (CRP)levels [70 mg/l]. (Figure 1)
The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) score was two on the day of her admission since she was older than 40 and detached body surface more than 10%. Viral markers and COVID-19 ( polymerase chain reaction) PCR was negative. He has been treated with dexamethasone 4 mg twice daily and cyclosporine 200 mg daily for 6 days. His lesions stopped developing after four days, and complete healing was noted after 14 days.
Ophthalmic antibiotics and corticosteroids eye drop was used for conjunctivitis treatment. On the other hand, elevated D-Dimer levels prompted the clinicians to evaluate and rule out Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE). No signs of DVT were found in ultrasonographic evaluations of lower limbs, PTE was also ruled out as ventilation and perfusion scan was carried out. The patient is currently under observation and the lesions have been completely cured.
(Figure 1)